Department of Neurosurgery, West China Hospital, Sichuan University, Xiang Street, Chengdu, Sichuan, 610041, People's Republic of China.
Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
Neurol Sci. 2017 Sep;38(9):1591-1597. doi: 10.1007/s10072-017-3006-6. Epub 2017 Jun 2.
In patients with spontaneous intracerebral hemorrhage (sICH), hematoma expansion (HE) is associated with poor outcome. Spot sign and black hole sign are neuroimaging predictors for HE. This study was aimed to compare the predictive value of two signs for HE. Within 6 h after onset of sICH, patients were screened for the computed tomography angiography spot sign and the non-contrast computed tomography black hole sign. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of two signs for HE prediction were calculated. The accuracy of two signs in predicting HE was analyzed by receiver-operator analysis. A total of 129 patients were included in this study. Spot sign was identified in 30 (23.3%) patients and black hole sign in 29 (22.5%) patients, respectively. Of 32 patients with HE, spot sign was observed in 19 (59.4%) and black hole sign was found in 14 (43.8%). The occurrence of black hole sign was significantly associated with spot sign (P < 0.001). The sensitivity, specificity, PPV, and NPV of spot sign for predicting HE were 59.38, 88.66, 63.33, and 86.87% respectively. In contrast, the sensitivity, specificity, PPV, and NPV of black hole sign for predicting HE were 43.75, 84.54, 48.28, and 82.00%, respectively. The area under the curve was 0.740 for spot sign and 0.641 for black hole sign. (P = 0.228) Both spot sign and black hole sign appeared to have good predictive value for HE, and spot sign seemed to be a better predictor.
在自发性脑出血（sICH）患者中，血肿扩大（HE）与不良预后相关。斑点征和黑洞征是预测 HE 的神经影像学标志物。本研究旨在比较这两种征象对 HE 的预测价值。在 sICH 发病后 6 小时内，对患者进行 CT 血管造影斑点征和非对比 CT 黑洞征筛查。计算两种征象预测 HE 的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。通过受试者工作特征分析评估两种征象预测 HE 的准确性。共纳入 129 例患者。分别有 30 例（23.3%）患者出现斑点征，29 例（22.5%）患者出现黑洞征。在 32 例 HE 患者中，19 例（59.4%）患者出现斑点征，14 例（43.8%）患者出现黑洞征。黑洞征的发生与斑点征显著相关（P<0.001）。斑点征预测 HE 的敏感性、特异性、PPV 和 NPV 分别为 59.38%、88.66%、63.33%和 86.87%。相比之下，黑洞征预测 HE 的敏感性、特异性、PPV 和 NPV 分别为 43.75%、84.54%、48.28%和 82.00%。斑点征的曲线下面积为 0.740，黑洞征的曲线下面积为 0.641。（P=0.228）斑点征和黑洞征似乎对 HE 均具有良好的预测价值，且斑点征似乎是更好的预测指标。
